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Chang HN, Chen CK, Yu TY, Pang JHS, Hsu CC, Lin LP, Tsai WC. Lidocaine inhibits migration of tenocytes by downregulating focal adhesion kinase and paxillin phosphorylation. J Orthop Res 2024; 42:985-992. [PMID: 38044475 DOI: 10.1002/jor.25762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 11/27/2023] [Accepted: 11/29/2023] [Indexed: 12/05/2023]
Abstract
Lidocaine is the most frequently applied local infiltration anesthetic agent for treating tendinopathies. However, studies have discovered lidocaine to negatively affect tendon healing. In the current study, the molecular mechanisms and effects of lidocaine on tenocyte migration were evaluated. We treated tenocytes intrinsic to the Achilles tendons of Sprague-Dawley rats with lidocaine. The migration ability of cells was analyzed using electric cell-substrate impedance sensing (ECIS) and scratch wound assay. We then used a microscope to evaluate the cell spread. We assessed filamentous actin (F-actin) cytoskeleton formation through immunofluorescence staining. In addition, we used Western blot analysis to analyze the expression of phospho-focal adhesion kinase (FAK), FAK, phospho-paxillin, paxillin, and F-actin. We discovered that lidocaine had an inhibitory effect on the migration of tenocytes in the scratch wound assay and on the ECIS chip. Lidocaine treatment suppressed cell spreading and changed the cell morphology and F-actin distribution. Lidocaine reduced F-actin formation in the tenocyte during cell spreading; furthermore, it inhibited phospho-FAK, F-actin, and phospho-paxillin expression in the tenocytes. Our study revealed that lidocaine inhibits the spread and migration of tenocytes. The molecular mechanism potentially underlying this effect is downregulation of F-actin, phospho-FAK, and phospho-paxillin expression when cells are treated with lidocaine.
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Affiliation(s)
- Hsiang-Ning Chang
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan
| | - Chih-Kuang Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Taoyuan, Taoyuan City, Taiwan
| | - Tung-Yang Yu
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan
| | - Jong-Hwei S Pang
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan City, Taiwan
| | - Chih-Chin Hsu
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Keelung, Keelung City, Taiwan
| | - Li-Ping Lin
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Taoyuan, Taoyuan City, Taiwan
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan City, Taiwan
| | - Wen-Chung Tsai
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Taoyuan, Taoyuan City, Taiwan
- School of Medicine, Chang Gung University, Taoyuan City, Taiwan
- Center of Comprehensive Sports Medicine, Chang Gung Memorial Hospital at Taoyuan, Taoyuan City, Taiwan
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Squier K, Scott A, Hunt MA, Brunham LR, Wilson DR, Screen H, Waugh CM. The effects of cholesterol accumulation on Achilles tendon biomechanics: A cross-sectional study. PLoS One 2021; 16:e0257269. [PMID: 34529718 PMCID: PMC8445482 DOI: 10.1371/journal.pone.0257269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 08/31/2021] [Indexed: 11/18/2022] Open
Abstract
Familial hypercholesterolemia, a common genetic metabolic disorder characterized by high cholesterol levels, is involved in the development of atherosclerosis and other preventable diseases. Familial hypercholesterolemia can also cause tendinous abnormalities, such as thickening and xanthoma (tendon lipid accumulation) in the Achilles, which may impede tendon biomechanics. The objective of this study was to investigate the effect of cholesterol accumulation on the biomechanical performance of Achilles tendons, in vivo. 16 participants (10 men, 6 women; 37±6 years) with familial hypercholesterolemia, diagnosed with tendon xanthoma, and 16 controls (10 men, 6 women; 36±7 years) underwent Achilles biomechanical assessment. Achilles biomechanical data was obtained during preferred pace, shod, walking by analysis of lower limb kinematics and kinetics utilizing 3D motion capture and an instrumented treadmill. Gastrocnemius medialis muscle-tendon junction displacement was imaged using ultrasonography. Achilles stiffness, hysteresis, strain and force were calculated from displacement-force data acquired during loading cycles, and tested for statistical differences using one-way ANOVA. Statistical parametric mapping was used to examine group differences in temporal data. Participants with familial hypercholesterolemia displayed lower Achilles stiffness compared to the control group (familial hypercholesterolemia group: 87±20 N/mm; controls: 111±18 N/mm; p = 0.001), which appeared to be linked to Achilles loading rate rather than an increased strain (FH: 5.27±1.2%; controls: 4.95±0.9%; p = 0.413). We found different Achilles loading patterns in the familial hypercholesterolemia group, which were traced to differences in the centre of pressure progression that affected ankle moment. This finding may indicate that individuals with familial hypercholesterolemia use different Achilles loading strategies. Participants with familial hypercholesterolemia also demonstrated significantly greater Achilles hysteresis than the control group (familial hypercholesterolemia: 57.5±7.3%; controls: 43.8±10%; p<0.001), suggesting that walking may require a greater metabolic cost. Our results indicate that cholesterol accumulation could contribute to reduced Achilles function, while potentially increasing the chance of injury.
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Affiliation(s)
- Kipling Squier
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Alexander Scott
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Michael A. Hunt
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Liam R. Brunham
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - David R. Wilson
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
- Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hazel Screen
- School of Engineering & Materials Science, Queen Mary University of London, London, United Kingdom
| | - Charlie M. Waugh
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
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Nuss CA, Huegel J, Finkielsztein S, Soslowsky LJ. Liquid Poly-N-acetyl Glucosamine (sNAG) Improves Achilles Tendon Healing in a Rat Model. Ann Biomed Eng 2021; 49:515-522. [PMID: 33409852 PMCID: PMC8178587 DOI: 10.1007/s10439-020-02711-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 12/14/2020] [Indexed: 11/25/2022]
Abstract
The Achilles tendon, while the strongest and largest tendon in the body, is frequently injured. Even after surgical repair, patients risk re-rupture and long-term deficits in function. Poly-N-acetyl glucosamine (sNAG) polymer has been shown to increase the rate of healing of venous leg ulcers, and use of this material improved tendon-to-bone healing in a rat model of rotator cuff injury. Therefore, the purpose of this study was to investigate the healing properties of liquid sNAG polymer suspension in a rat partial Achilles tear model. We hypothesized that repeated sNAG injections throughout healing would improve Achilles tendon healing as measured by improved mechanical properties and cellular morphology compared to controls. Results demonstrate that sNAG has a positive effect on rat Achilles tendon healing at three weeks after a full thickness, partial width injury. sNAG treatment led to increased quasistatic tendon stiffness, and increased tangent and secant stiffness throughout fatigue cycling protocols. Increased dynamic modulus also suggests improved viscoelastic properties with sNAG treatment. No differences were identified in histological properties. Importantly, use of this material did not have any negative effects on any measured parameter. These results support further study of this material as a minimally invasive treatment modality for tendon healing.
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Affiliation(s)
- Courtney A Nuss
- McKay Orthopaedic Research Laboratory, University of Pennsylvania, 3450 Hamilton Walk, 371 Stemmler Hall, Philadelphia, PA, 19104-6081, USA
| | - Julianne Huegel
- McKay Orthopaedic Research Laboratory, University of Pennsylvania, 3450 Hamilton Walk, 371 Stemmler Hall, Philadelphia, PA, 19104-6081, USA
| | - Sergio Finkielsztein
- Marine Polymer Technologies, Inc., 1 Van De Graaff Drive, Suite 302, Burlington, MA, 01803, USA
| | - Louis J Soslowsky
- McKay Orthopaedic Research Laboratory, University of Pennsylvania, 3450 Hamilton Walk, 371 Stemmler Hall, Philadelphia, PA, 19104-6081, USA.
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Khayyeri H, Hammerman M, Turunen MJ, Blomgran P, Notermans T, Guizar-Sicairos M, Eliasson P, Aspenberg P, Isaksson H. Diminishing effects of mechanical loading over time during rat Achilles tendon healing. PLoS One 2020; 15:e0236681. [PMID: 33315857 PMCID: PMC7735574 DOI: 10.1371/journal.pone.0236681] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 11/23/2020] [Indexed: 01/07/2023] Open
Abstract
Mechanical loading affects tendon healing and recovery. However, our understanding about how physical loading affects recovery of viscoelastic functions, collagen production and tissue organisation is limited. The objective of this study was to investigate how different magnitudes of loading affects biomechanical and collagen properties of healing Achilles tendons over time. Achilles tendon from female Sprague Dawley rats were cut transversely and divided into two groups; normal loading (control) and reduced loading by Botox (unloading). The rats were sacrificed at 1, 2- and 4-weeks post-injury and mechanical testing (creep test and load to failure), small angle x-ray scattering (SAXS) and histological analysis were performed. The effect of unloading was primarily seen at the early time points, with inferior mechanical and collagen properties (SAXS), and reduced histological maturation of the tissue in unloaded compared to loaded tendons. However, by 4 weeks no differences remained. SAXS and histology revealed heterogeneous tissue maturation with more mature tissue at the peripheral region compared to the center of the callus. Thus, mechanical loading advances Achilles tendon biomechanical and collagen properties earlier compared to unloaded tendons, and the spatial variation in tissue maturation and collagen organization across the callus suggests important regional (mechano-) biological activities that require more investigation.
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Affiliation(s)
- Hanifeh Khayyeri
- Department of Biomedical Engineering, Lund University, Lund, Sweden
| | - Malin Hammerman
- Department of Biomedical Engineering, Lund University, Lund, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Mikael J. Turunen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Parmis Blomgran
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Thomas Notermans
- Department of Biomedical Engineering, Lund University, Lund, Sweden
| | | | - Pernilla Eliasson
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Per Aspenberg
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Hanna Isaksson
- Department of Biomedical Engineering, Lund University, Lund, Sweden
- * E-mail:
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Jewson J, Lambert E, Sari C, Jona E, Shorakae S, Lambert G, Gaida J. Does moxonidine reduce Achilles tendon or musculoskeletal pain in women with polycystic ovarian syndrome? A secondary analysis of a randomised controlled trial. BMC Endocr Disord 2020; 20:131. [PMID: 32847570 PMCID: PMC7449016 DOI: 10.1186/s12902-020-00610-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 08/14/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sympathetic activity and insulin resistance have recently been linked with chronic tendon and musculoskeletal pain. Polycystic ovarian syndrome is linked with insulin resistance and increased sympathetic drive and was therefore an appropriate condition to study the effects of modulating sympathetic activity on Achilles tendon and musculoskeletal symptoms. METHODS A secondary analysis of a double-blinded, randomised controlled trial on women with polycystic ovarian syndrome was conducted. Participants received 12 weeks of moxonidine (n = 14) or placebo (n = 18). Musculoskeletal symptom and Victorian Institute of Sport Assessment - Achilles (VISA-A) questionnaires were distributed, and ultrasound tissue characterisation quantified tendon structure at 0 and 12 weeks. 2-way ANOVA was used for multiple comparisons. RESULTS There was no difference in mean change in musculoskeletal symptoms (- 0.6 ± 1.7 vs - 0.4 ± 1.8, p = 0.69) or VISA-A (moxonidine - 0.2 ± 8.8 vs placebo + 4.2 ± 14.6, p = 0.24) attributable to the intervention. There was no difference in any measures of Achilles structure. Moxonidine did not reduce sympathetic drive when compared to placebo. CONCLUSIONS This was the first study to investigate the effects of blocking sympathetic drive on musculoskeletal and Achilles tendon symptoms in a metabolically diverse population. While the study was limited by small sample size and lack of sympathetic modulation, moxonidine did not change tendon pain/structure or musculoskeletal symptoms. TRIAL REGISTRATION ClinicalTrials.gov, NCT01504321 . Registered 5 January 2012.
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Affiliation(s)
- Jacob Jewson
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.
- Present Address: Olympic Park Sports Medicine Centre, Melbourne, Victoria, Australia.
| | - Elisabeth Lambert
- Iverson Health Innovation Research Institute and School of Health Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Carolina Sari
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Eveline Jona
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Soulmaz Shorakae
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, Victoria, Australia
| | - Gavin Lambert
- Iverson Health Innovation Research Institute and School of Health Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Jamie Gaida
- University of Canberra Research Institute for Sport and Exercise (UCRISE), Canberra, ACT, Australia
- Discipline of Physiotherapy, University of Canberra, Canberra, ACT, Australia
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Li YP, Feng YN, Liu CL, Zhang ZJ. Paraffin therapy induces a decrease in the passive stiffness of gastrocnemius muscle belly and Achilles tendon: A randomized controlled trial. Medicine (Baltimore) 2020; 99:e19519. [PMID: 32195954 PMCID: PMC7220386 DOI: 10.1097/md.0000000000019519] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The purposes of this study were to examine the feasibility of using the MyotonPRO digital palpation device in measuring the passive stiffness of gastrocnemius muscle belly and Achilles tendon; to determine between-days test-retest reliability of MyotonPRO; and to evaluate the acute effect of paraffin therapy on stiffness measurements in healthy participants. METHODS It is a randomized controlled trial. Twenty healthy participants (male, n = 10; female, n = 10; total, n = 20) were recruited to evaluate the passive stiffness of gastrocnemius muscle belly and Achilles tendon. Dominant and nondominant legs were randomly divided into an experimental side (20 cases) and a control side (20 cases). The experimental side received 20 minutes of paraffin therapy. RESULTS The stiffness of muscle and tendon in the experimental side decreased significantly after paraffin therapy (P < .01), whereas no significant differences in stiffness measurements were found in the control side (P > .05). The passive stiffness of muscle and tendon was positively correlated with the ankle from 30° plantar flexion to10° dorsiflexion for dominant legs. Between-days test-retest reliability in stiffness measurements was high or very high (ICCs were above 0.737). CONCLUSION Paraffin therapy induces a decrease in the passive stiffness of gastrocnemius muscle belly and Achilles tendon. Furthermore, the MyotonPRO can reliably determine stiffness measurements.
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Affiliation(s)
- Ya Peng Li
- Rehabilitation Therapy Center, Luoyang Orthopedic Hospital of Henan Province, Luoyang
| | - Ya Nan Feng
- Rehabilitation Therapy Center, Luoyang Orthopedic Hospital of Henan Province, Luoyang
| | - Chun Long Liu
- Clinical Medical College of Acupuncture, Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhi Jie Zhang
- Rehabilitation Therapy Center, Luoyang Orthopedic Hospital of Henan Province, Luoyang
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Evrova O, Kellenberger D, Calcagni M, Vogel V, Buschmann J. Supporting Cell-Based Tendon Therapy: Effect of PDGF-BB and Ascorbic Acid on Rabbit Achilles Tenocytes in Vitro. Int J Mol Sci 2020; 21:ijms21020458. [PMID: 31936891 PMCID: PMC7014238 DOI: 10.3390/ijms21020458] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 01/07/2020] [Accepted: 01/09/2020] [Indexed: 12/21/2022] Open
Abstract
Cell-based tendon therapies with tenocytes as a cell source need effective tenocyte in vitro expansion before application for tendinopathies and tendon injuries. Supplementation of tenocyte culture with biomolecules that can boost proliferation and matrix synthesis is one viable option for supporting cell expansion. In this in vitro study, the impacts of ascorbic acid or PDGF-BB supplementation on rabbit Achilles tenocyte culture were studied. Namely, cell proliferation, changes in gene expression of several ECM and tendon markers (collagen I, collagen III, fibronectin, aggrecan, biglycan, decorin, ki67, tenascin-C, tenomodulin, Mohawk, α-SMA, MMP-2, MMP-9, TIMP1, and TIMP2) and ECM deposition (collagen I and fibronectin) were assessed. Ascorbic acid and PDGF-BB enhanced tenocyte proliferation, while ascorbic acid significantly accelerated the deposition of collagen I. Both biomolecules led to different changes in the gene expression profile of the cultured tenocytes, where upregulation of collagen I, Mohawk, decorin, MMP-2, and TIMP-2 was observed with ascorbic acid, while these markers were downregulated by PDGF-BB supplementation. Vice versa, there was an upregulation of fibronectin, biglycan and tenascin-C by PDGF-BB supplementation, while ascorbic acid led to a downregulation of these markers. However, both biomolecules are promising candidates for improving and accelerating the in vitro expansion of tenocytes, which is vital for various tendon tissue engineering approaches or cell-based tendon therapy.
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Affiliation(s)
- Olivera Evrova
- Division of Plastic Surgery and Hand Surgery, University Hospital Zurich, Sternwartstrasse 14, 8091 Zurich, Switzerland; (O.E.); (M.C.)
- Laboratory of Applied Mechanobiology, ETH Zurich, Vladimir-Prelog-Weg 4, 8093 Zurich, Switzerland; (D.K.); (V.V.)
| | - Damian Kellenberger
- Laboratory of Applied Mechanobiology, ETH Zurich, Vladimir-Prelog-Weg 4, 8093 Zurich, Switzerland; (D.K.); (V.V.)
| | - Maurizio Calcagni
- Division of Plastic Surgery and Hand Surgery, University Hospital Zurich, Sternwartstrasse 14, 8091 Zurich, Switzerland; (O.E.); (M.C.)
| | - Viola Vogel
- Laboratory of Applied Mechanobiology, ETH Zurich, Vladimir-Prelog-Weg 4, 8093 Zurich, Switzerland; (D.K.); (V.V.)
| | - Johanna Buschmann
- Division of Plastic Surgery and Hand Surgery, University Hospital Zurich, Sternwartstrasse 14, 8091 Zurich, Switzerland; (O.E.); (M.C.)
- Correspondence: ; Tel.: +41-44-255-9895
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8
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Arslan İ, Yücel I, Öztürk TB, Karahan N, Orak MM, Midi A. The Effects of Corticosteroid Injection in the Healthy and Damaged Achilles Tendon Model: Histopathological and Biomechanical Experimental Study in Rats. Turk Patoloji Derg 2020; 36:39-47. [PMID: 31538652 PMCID: PMC10512677 DOI: 10.5146/tjpath.2019.01468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 09/01/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To show the effects of corticosteroids on inflammatory reactions in the injured Achilles tendon in rats. MATERIAL AND METHOD Thirty-two adult Wistar Albino rats were used in the study. The rats were divided into 4 groups. In the first group (Intact Saline), saline solution was injected to the intact Achilles tendon. In the second group (Intact Corticosteroid), corticosteroid was injected to the intact tendon. In the third group (Injured Saline), saline solution was injected to the injured Achilles tendon. In the fourth group (Injured Corticosteroid), corticosteroid was injected to the injured tendon. All groups were sacrificed on day 30 and Achilles tendons were taken and prepared for histological and biomechanical evaluation. RESULTS According to the biomechanical test; mean load-to-failure of the Intact Saline group was significantly lower than the Intact Corticosteroid (p=0.016), Injured Saline (p=0.001) and Injured Corticosteroid) (p=0.012) groups. According to the histopathological evaluation, tenocyte mean of the Intact Saline group was statistically lower than the Injured Saline and Injured Corticosteroid groups. Tenocyte mean of the Intact Corticosteroid group was statistically significantly lower than the Injured Saline and Injured Corticosteroid groups. The ground substance mean of the Intact Saline group was significantly lower than the Injured Saline and Injured Corticosteroid groups. The ground substance mean of the Intact Corticosteroid group was significantly lower than the Injured Saline and Injured Corticosteroid groups. There was no statistically significant difference between the groups in terms of calcification. CONCLUSION It has been found that there is biomechanical and histopathological significant benefit of intra-tendon corticosteroid administration in the experimentally generated Achilles tendon injury model.
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Affiliation(s)
- İlyas Arslan
- Department of Orthopedics and Traumatology, Fatih Sultan Mehmet Training and Research Hospital, İstanbul, Turkey
| | - Istemi Yücel
- Department of Orthopedics and Traumatology, Fatih Sultan Mehmet Training and Research Hospital, İstanbul, Turkey
| | - Turhan Beyza Öztürk
- Department of 2nd Grade Student, İstanbul Bahçeşehir University Faculty of Medicine, İstanbul, Turkey
| | - Nazım Karahan
- Department of Orthopedics and Traumatology, Fatih Sultan Mehmet Training and Research Hospital, İstanbul, Turkey
| | - M. Müfit Orak
- Department of Orthopedics and Traumatology, İstanbul Bahçeşehir University Faculty of Medicine, İstanbul, Turkey
| | - Ahmet Midi
- Department of Pathology, İstanbul Bahçeşehir University Faculty of Medicine, İstanbul, Turkey
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Sarver DC, Sugg KB, Talarek JR, Swanson JB, Oliver DJ, Hinken AC, Kramer HF, Mendias CL. Prostaglandin D 2 signaling is not involved in the recovery of rat hind limb tendons from injury. Physiol Rep 2019; 7:e14289. [PMID: 31782241 PMCID: PMC6882956 DOI: 10.14814/phy2.14289] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 10/24/2019] [Accepted: 10/25/2019] [Indexed: 12/19/2022] Open
Abstract
Injured tendons heal through the formation of a fibrovascular scar that has inferior mechanical properties compared to native tendon tissue. Reducing inflammation that occurs as a result of the injury could limit scar formation and improve functional recovery of tendons. Prostaglandin D2 (PGD2 ) plays an important role in promoting inflammation in some injury responses and chronic disease processes, and the inhibition of PGD2 has improved healing and reduced disease burden in animal models and early clinical trials. Based on these findings, we sought to determine the role of PGD2 signaling in the healing of injured tendon tissue. We tested the hypothesis that a potent and specific inhibitor of hematopoietic PGD synthase (HPGDS), GSK2894631A, would improve the recovery of tendons of adult male rats following an acute tenotomy and repair. To test this hypothesis, we performed a full-thickness plantaris tendon tenotomy followed by immediate repair and treated rats twice daily with either 0, 2, or 6 mg/kg of GSK2894631A. Tendons were collected either 7 or 21 days after surgical repair, and mechanical properties of tendons were assessed along with RNA sequencing and histology. While there were some differences in gene expression across groups, the targeted inhibition of HPGDS did not impact the functional repair of tendons after injury, as HPGDS expression was surprisingly low in injured tendons. These results indicate that PGD2 signaling does not appear to be important in modulating the repair of injured tendon tissue.
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Affiliation(s)
- Dylan C. Sarver
- Department of Orthopaedic SurgerySection of Plastic & Reconstructive SurgeryUniversity of Michigan Medical SchoolAnn ArborMIUSA
- Present address:
Department of PhysiologyJohns Hopkins University School of MedicineBaltimoreMDUSA
| | - Kristoffer B. Sugg
- Department of Orthopaedic SurgerySection of Plastic & Reconstructive SurgeryUniversity of Michigan Medical SchoolAnn ArborMIUSA
- Department of Molecular & Integrative PhysiologySection of Plastic & Reconstructive SurgeryUniversity of Michigan Medical SchoolAnn ArborMIUSA
- Department of SurgerySection of Plastic & Reconstructive SurgeryUniversity of Michigan Medical SchoolAnn ArborMIUSA
| | - Jeffrey R. Talarek
- Department of Orthopaedic SurgerySection of Plastic & Reconstructive SurgeryUniversity of Michigan Medical SchoolAnn ArborMIUSA
- Department of Molecular & Integrative PhysiologySection of Plastic & Reconstructive SurgeryUniversity of Michigan Medical SchoolAnn ArborMIUSA
- Hospital for Special SurgeryNew YorkNYUSA
| | | | | | - Aaron C. Hinken
- Muscle Metabolism DPUGlaxoSmithKline PharmaceuticalsKing of PrussiaPAUSA
| | - Henning F. Kramer
- Muscle Metabolism DPUGlaxoSmithKline PharmaceuticalsKing of PrussiaPAUSA
| | - Christopher L. Mendias
- Department of Orthopaedic SurgerySection of Plastic & Reconstructive SurgeryUniversity of Michigan Medical SchoolAnn ArborMIUSA
- Department of Molecular & Integrative PhysiologySection of Plastic & Reconstructive SurgeryUniversity of Michigan Medical SchoolAnn ArborMIUSA
- Hospital for Special SurgeryNew YorkNYUSA
- Department of Physiology & BiophysicsWeill Cornell Medical CollegeNew YorkNYUSA
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10
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Patel SH, Yue F, Saw SK, Foguth R, Cannon JR, Shannahan JH, Kuang S, Sabbaghi A, Carroll CC. Advanced Glycation End-Products Suppress Mitochondrial Function and Proliferative Capacity of Achilles Tendon-Derived Fibroblasts. Sci Rep 2019; 9:12614. [PMID: 31471548 PMCID: PMC6717202 DOI: 10.1038/s41598-019-49062-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 08/16/2019] [Indexed: 02/07/2023] Open
Abstract
Debilitating cases of tendon pain and degeneration affect the majority of diabetic individuals. The high rate of tendon degeneration persists even when glucose levels are well controlled, suggesting that other mechanisms may drive tendon degeneration in diabetic patients. The purpose of this study was to investigate the impact of advanced glycation end-products on tendon fibroblasts to further our mechanistic understanding of the development and progression of diabetic tendinopathy. We proposed that advanced glycation end-products would induce limitations to mitochondrial function and proliferative capacity in tendon-derived fibroblasts, restricting their ability to maintain biosynthesis of tendon extracellular matrix. Using an in-vitro cell culture system, rat Achilles tendon fibroblasts were treated with glycolaldehyde-derived advanced glycation end-products (0, 50, 100, and 200 μg/ml) for 48 hours in normal glucose (5.5 mM) and high glucose (25 mM) conditions. We demonstrate that tendon fibroblasts treated with advanced glycation end-products display reduced ATP production, electron transport efficiency, and proliferative capacity. These impairments were coupled with alterations in mitochondrial DNA content and expression of genes associated with extracellular matrix remodeling, mitochondrial energy metabolism, and apoptosis. Our findings suggest that advanced glycation end-products disrupt tendon fibroblast homeostasis and may be involved in the development and progression of diabetic tendinopathy.
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Affiliation(s)
- Shivam H Patel
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN, USA
| | - Feng Yue
- Department of Animal Sciences, Purdue University, West Lafayette, IN, USA
| | - Shannon K Saw
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN, USA
| | - Rachel Foguth
- School of Health Sciences, Purdue University, West Lafayette, IN, USA
- Purdue Institute for Integrative Neuroscience, West Lafayette, IN, USA
| | - Jason R Cannon
- School of Health Sciences, Purdue University, West Lafayette, IN, USA
- Purdue Institute for Integrative Neuroscience, West Lafayette, IN, USA
| | | | - Shihuan Kuang
- Department of Animal Sciences, Purdue University, West Lafayette, IN, USA
| | - Arman Sabbaghi
- Department of Statistics, Purdue University, West Lafayette, IN, USA
| | - Chad C Carroll
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN, USA.
- Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indianapolis, IN, USA.
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11
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Hochstrat E, Müller M, Frank A, Michel P, Hansen U, Raschke MJ, Kronenberg D, Stange R. Cryopreservation of tendon tissue using dimethyl sulfoxide combines conserved cell vitality with maintained biomechanical features. PLoS One 2019; 14:e0215595. [PMID: 31002728 PMCID: PMC6474606 DOI: 10.1371/journal.pone.0215595] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 04/04/2019] [Indexed: 01/31/2023] Open
Abstract
Biomechanical research on tendon tissue evaluating new treatment strategies to frequently occurring clinical problems regarding tendon degeneration or trauma is of expanding scientific interest. In this context, storing tendon tissue deep-frozen is common practice to collect tissue and analyze it under equal conditions. The commonly used freezing medium, phosphate buffered saline, is known to damage cells and extracellular matrix in frozen state. Dimethyl sulfoxide, however, which is used for deep-frozen storage of cells in cell culture preserves cell vitality and reduces damage to the extracellular matrix during freezing. In our study, Achilles tendons of 26 male C57/Bl6 mice were randomized in five groups. Tendons were deep frozen in dimethyl sulfoxide or saline undergoing one or four freeze-thaw-cycles and compared to an unfrozen control group analyzing biomechanical properties, cell viability and collagenous structure. In electron microscopy, collagen fibrils of tendons frozen in saline appeared more irregular in shape, while dimethyl sulfoxide preserved the collagenous structure during freezing. In addition, treatment with dimethyl sulfoxide preserved cell viability visualized with an MTT-Assay, while tendons frozen in saline showed no remaining metabolic activity, indicating total destruction of cells during freezing. The biomechanical results revealed no differences between tendons frozen once in saline or dimethyl sulfoxide. However, tendons frozen four times in saline showed a significantly higher Young’s modulus over all strain rates compared to unfrozen tendons. In conclusion, dimethyl sulfoxide preserves the vitality of tendon resident cells and protects the collagenous superstructure during the freezing process resulting in maintained biomechanical properties of the tendon.
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Affiliation(s)
- Eva Hochstrat
- Department of Regenerative Musculoskeletal Medicine, Institute for Musculoskeletal Medicine, University Hospital Münster, Westfälische Wilhelms-University, Münster, Germany
| | - Marcus Müller
- Department of Trauma-, Hand-, and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Andre Frank
- Department of Trauma-, Hand-, and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Philipp Michel
- Department of Regenerative Musculoskeletal Medicine, Institute for Musculoskeletal Medicine, University Hospital Münster, Westfälische Wilhelms-University, Münster, Germany
- Department of Trauma-, Hand-, and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Uwe Hansen
- Department of Molecular Medicine, Institute for Musculoskeletal Medicine, Westfälische Wilhelms-University, Münster, Germany
| | - Michael J. Raschke
- Department of Trauma-, Hand-, and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Daniel Kronenberg
- Department of Regenerative Musculoskeletal Medicine, Institute for Musculoskeletal Medicine, University Hospital Münster, Westfälische Wilhelms-University, Münster, Germany
| | - Richard Stange
- Department of Regenerative Musculoskeletal Medicine, Institute for Musculoskeletal Medicine, University Hospital Münster, Westfälische Wilhelms-University, Münster, Germany
- * E-mail:
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12
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Bergqvist F, Carr AJ, Wheway K, Watkins B, Oppermann U, Jakobsson PJ, Dakin SG. Divergent roles of prostacyclin and PGE 2 in human tendinopathy. Arthritis Res Ther 2019; 21:74. [PMID: 30867043 PMCID: PMC6416900 DOI: 10.1186/s13075-019-1855-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 02/27/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Tendon disease is a significant global healthcare burden whereby patients experience pain and disability; however, the mechanisms that underlie inflammation and pain are poorly understood. Herein, we investigated the role of prostaglandins as important mediators of inflammation and pain in tissues and cells derived from patients with tendinopathy. METHODS We studied supraspinatus and Achilles tendon biopsies from symptomatic patients with tendinopathy or rupture. Tendon-derived stromal cells (CD45negCD34neg) isolated from tendons were cultured and treated with interleukin-1β (IL-1β) to investigate prostaglandin production. RESULTS Diseased tendon tissues showed increased expression of prostacyclin receptor (IP) and enzymes catalyzing the biosynthesis of prostaglandins, including cyclooxygenase-1 (COX-1), COX-2, prostacyclin synthase (PGIS), and microsomal prostaglandin E synthase-1 (mPGES-1). PGIS co-localized with cells expressing Podoplanin, a marker of stromal fibroblast activation, and the nociceptive neuromodulator NMDAR-1. Treatment with IL-1β induced release of the prostacyclin metabolite 6-keto PGF1α in tendon cells isolated from diseased supraspinatus and Achilles tendons but not in cells from healthy comparator tendons. The same treatment induced profound prostaglandin E2 (PGE2) release in tendon cells derived from patients with supraspinatus tendon tears. Incubation of IL-1β treated diseased tendon cells with selective mPGES-1 inhibitor Compound III, reduced PGE2, and simultaneously increased 6-keto PGF1α production. Conversely, COX blockade with naproxen or NS-398 inhibited both PGE2 and 6-keto PGF1α production. Tendon biopsies from patients in whom symptoms had resolved showed increased PTGIS compared to biopsies from patients with persistent tendinopathy. CONCLUSIONS Our results suggest that PGE2 sustains inflammation and pain while prostacyclin may have a protective role in human tendon disease.
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Affiliation(s)
- Filip Bergqvist
- Rheumatology Unit, Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, SE-17176 Stockholm, Sweden
| | - Andrew J. Carr
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Nuffield Orthopaedic Centre, Headington, OX3 7LD UK
| | - Kim Wheway
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Nuffield Orthopaedic Centre, Headington, OX3 7LD UK
| | - Bridget Watkins
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Nuffield Orthopaedic Centre, Headington, OX3 7LD UK
| | - Udo Oppermann
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Nuffield Orthopaedic Centre, Headington, OX3 7LD UK
- Structural Genomics Consortium, University of Oxford, Old Road Campus, Headington, OX3 7DQ UK
| | - Per-Johan Jakobsson
- Rheumatology Unit, Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, SE-17176 Stockholm, Sweden
| | - Stephanie G. Dakin
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Nuffield Orthopaedic Centre, Headington, OX3 7LD UK
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13
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Marques PP, Vieira CP, de Oliveira LP, Pimentel ER, Guerra FDR. Chronical treatment with sildenafil causes Achilles tendinopathy in rats. Life Sci 2018; 212:87-92. [PMID: 30267787 DOI: 10.1016/j.lfs.2018.09.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 09/10/2018] [Accepted: 09/25/2018] [Indexed: 01/05/2023]
Abstract
AIMS The primary goal was to assess the effects of chronic sildenafil treatment over the Achilles tendons in rats. MAIN METHODS Animals were divided into two groups, control and sildenafil administration (n = 5). After 60 days, the tendons were subject to biochemical and image analysis to compare tendons between the groups: collagen I and decorin content, polarisation microscopy and birefringence analysis, and tissue zymography. KEY FINDINGS The animals exposed to sildenafil presented a much less organised tendon matrix, with reduced collagen I and non-collagenous protein content and a much higher decorin content. SIGNIFICANCE The results observed in the animals can be characterised as tendinopathy, a condition not yet described as a sildenafil side effect.
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Affiliation(s)
- Petrus Pires Marques
- Department of Medicine, José do Rosário Vellano University - Unifenas, 37130-000 Alfenas, MG, Brazil.
| | - Cristiano Pedrozo Vieira
- Department of Pharmacology, Faculty of Medical Sciences, State University of Campinas - UNICAMP, 13083-970 Campinas, SP, Brazil
| | - Letícia Prado de Oliveira
- Department of Anatomy, Cell Biology and Physiology and Biophysics, Institute of Biology, CP 6109, University of Campinas - UNICAMP, 13083-970 Campinas, SP, Brazil
| | - Edson Rosa Pimentel
- Department of Anatomy, Cell Biology and Physiology and Biophysics, Institute of Biology, CP 6109, University of Campinas - UNICAMP, 13083-970 Campinas, SP, Brazil
| | - Flávia Da Ré Guerra
- Department of Anatomy, Institute of Biomedical Science, Federal University of Alfenas - UNIFAL-MG, 37130-000 Alfenas, MG, Brazil
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14
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Beytemür O, Yüksel S, Tetikkurt ÜS, Genç E, Olcay E, Güleç A. Isotretinoin induced achilles tendinopathy: Histopathological and biomechanical evaluation on rats. Acta Orthop Traumatol Turc 2018; 52:387-391. [PMID: 30017488 PMCID: PMC6204476 DOI: 10.1016/j.aott.2018.06.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 06/13/2018] [Accepted: 06/19/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The aim of the present study was to evaluate histopathological and biomechanical effects of isotretinoin on Achilles tendon. MATERIALS & METHODS Sixteen rats were divided into two groups including the control group (n = 8) and isotretinoin group (n = 8). The control group received 1.42 ml/kg soy oil per day whereas the isotretinoin group received 15 mg/kg/day (gavage dose 1.42 ml/kg) isotretinoin dissolved in soy oil through gavage method for 6 weeks. Achilles tendons were excised at the end of week 6. The tendon samples were evaluated by hematoxylin-eosin under a light microscope. Quantitative evaluation was performed via Movin and Bonar scoring. A computer-monitored tensile testing machine was utilised for biomechanical testing. Biomechanical characteristics of the tendon samples (elastic modulus, yield force, ultimate tensile force) were measured. RESULTS Histopathological evaluation revealed a significantly higher Movin and Bonar scores in histopathological evaluation. Movin score in isotretinoin group was 4.1 ± 2.5 and it was 2.3 ± 1.0 in control group (p = 0.032). Bonar score in isotretinoin group was 2.9 ± 1.4 and it was 1.6 ± 0.7 in control group (p = 0.022). In line with histopathological evaluation, biomechanical measurements in isotretinoin group (elastic modulus, yield force, ultimate tensile force) were significantly lower than the control group. Elastic modulus in isotretinoin group was 227 ± 27.7 N/mm2 and in control group it was 281.7 ± 38.7 N/mm2 (p = 0.006). In isotretinoin group; yield force was 33.7 ± 4.3 Pa and in control group it was 40.8 ± 5.9 Pa (p = 0.021). Ultimate tensile force in isotretinoin group was 35.7 ± 4.2 Pa and in control group it was 44 ± 7 Pa (p = 0.009). CONCLUSION The present study detected histopathological and biomechanical negative effect of isotretinoin on Achilles tendon. Therefore, isotretinoin should be questioned in medical history of patients with tendinopathy.
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Affiliation(s)
- Ozan Beytemür
- Bağcılar Training and Research Hospital, Department of Orthopedics and Traumatology, İstanbul, Turkey.
| | - Serdar Yüksel
- Bağcılar Training and Research Hospital, Department of Orthopedics and Traumatology, İstanbul, Turkey.
| | - Ümit Seza Tetikkurt
- Bağcılar Training and Research Hospital, Department of Pathology, İstanbul, Turkey.
| | - Erdinç Genç
- Bağcılar Training and Research Hospital, Department of Orthopedics and Traumatology, İstanbul, Turkey.
| | - Ercan Olcay
- İstanbul Kanuni Sultan Süleyman Training and Research Hospital, Department of Orthopedics and Traumatology, İstanbul, Turkey.
| | - Akif Güleç
- Bağcılar Training and Research Hospital, Department of Orthopedics and Traumatology, İstanbul, Turkey.
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15
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Wang X, Li F, Xie L, Crane J, Zhen G, Mishina Y, Deng R, Gao B, Chen H, Liu S, Yang P, Gao M, Tu M, Wang Y, Wan M, Fan C, Cao X. Inhibition of overactive TGF-β attenuates progression of heterotopic ossification in mice. Nat Commun 2018; 9:551. [PMID: 29416028 PMCID: PMC5803194 DOI: 10.1038/s41467-018-02988-5] [Citation(s) in RCA: 117] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 01/11/2018] [Indexed: 12/24/2022] Open
Abstract
Acquired heterotopic ossification (HO) is a painful and debilitating disease characterized by extraskeletal bone formation after injury. The exact pathogenesis of HO remains unknown. Here we show that TGF-β initiates and promotes HO in mice. We find that calcified cartilage and newly formed bone resorb osteoclasts after onset of HO, which leads to high levels of active TGF-β that recruit mesenchymal stromal/progenitor cells (MSPCs) in the HO microenvironment. Transgenic expression of active TGF-β in tendon induces spontaneous HO, whereas systemic injection of a TGF-β neutralizing antibody attenuates ectopic bone formation in traumatic and BMP-induced mouse HO models, and in a fibrodysplasia ossificans progressive mouse model. Moreover, inducible knockout of the TGF-β type II receptor in MSPCs inhibits HO progression in HO mouse models. Our study points toward elevated levels of active TGF-β as inducers and promoters of ectopic bone formation, and suggest that TGF-β might be a therapeutic target in HO.
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MESH Headings
- Achilles Tendon/drug effects
- Achilles Tendon/injuries
- Adult
- Animals
- Antibodies, Neutralizing/pharmacology
- Becaplermin/metabolism
- Bone Remodeling
- Brain Injuries, Traumatic
- Cartilage
- Case-Control Studies
- Disease Models, Animal
- Elbow Joint/surgery
- Female
- Fracture Fixation, Internal
- Fractures, Bone
- Humans
- Male
- Mesenchymal Stem Cells/metabolism
- Mice
- Mice, Knockout
- Mice, Transgenic
- Middle Aged
- Muscle, Skeletal/pathology
- Myositis Ossificans/metabolism
- Ossification, Heterotopic/metabolism
- Osteoclasts
- Osteogenesis/drug effects
- Receptor, Transforming Growth Factor-beta Type II/genetics
- Spinal Cord Injuries
- Tendon Injuries
- Tendons
- Transforming Growth Factor beta/antagonists & inhibitors
- Transforming Growth Factor beta/metabolism
- Transforming Growth Factor beta1/metabolism
- Young Adult
- Elbow Injuries
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Affiliation(s)
- Xiao Wang
- Department of Orthopedic Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Fengfeng Li
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital, 200030, Shanghai, China
| | - Liang Xie
- Department of Orthopedic Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Janet Crane
- Department of Orthopedic Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Gehua Zhen
- Department of Orthopedic Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Yuji Mishina
- School of Dentistry, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Ruoxian Deng
- Department of Orthopedic Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Bo Gao
- Department of Orthopedic Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Hao Chen
- Department of Orthopedic Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Shen Liu
- Department of Orthopedic Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD, 21205, USA
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital, 200030, Shanghai, China
| | - Ping Yang
- Department of Orthopedic Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Manman Gao
- Department of Orthopedic Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Manli Tu
- Department of Orthopedic Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Yiguo Wang
- Department of Orthopedic Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Mei Wan
- Department of Orthopedic Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Cunyi Fan
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital, 200030, Shanghai, China
| | - Xu Cao
- Department of Orthopedic Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD, 21205, USA.
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16
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Zhang C, Wang X, Zhang E, Yang L, Yuan H, Tu W, Zhang H, Yin Z, Shen W, Chen X, Zhang Y, Ouyang H. An epigenetic bioactive composite scaffold with well-aligned nanofibers for functional tendon tissue engineering. Acta Biomater 2018; 66:141-156. [PMID: 28963019 DOI: 10.1016/j.actbio.2017.09.036] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 09/25/2017] [Accepted: 09/25/2017] [Indexed: 12/19/2022]
Abstract
Poor tendon repair is often a clinical challenge due to the lack of ideal biomaterials. Electrospun aligned fibers, resembling the ultrastructure of tendon, have been previously reported to promote tenogenesis. However, the underlying mechanism is unclear and the aligned fibers alone are not capable enough to commit teno-differentiation of stem cells. Here, based on our observation of reduced expression of histone deacetylases (HDACs) in tendon stem/progenitor cells (TSPCs) cultured on aligned fibers, we proposed a strategy to enhance the tenogenesis effect of aligned fibers by using a small molecule Trichostatin A (TSA), an HDAC inhibitor. Such a TSA-laden poly (l-lactic acid) (PLLA) aligned fiber (A-TSA) scaffold was successfully fabricated by a stable jet electrospinning method, and demonstrated its sustained capability in releasing TSA. We found that TSA incorporated aligned fibers of PLLA had an additive effect in directing tenogenic differentiation. Moreover, the in situ implantation study in rat model further confirmed that A-TSA scaffold promoted the structural and mechanical properties of the regenerated Achilles tendon. This study demonstrated that HDAC was involved in the teno-differentiation with aligned fiber topography, and the combination of HDAC with aligned topography might be a more efficient strategy to promote tenogenesis of stem cells. STATEMENT OF SIGNIFICANCE Electrospun aligned fibers, resembling the ultrastructure of tendon, have been previously reported to promote tenogenesis. However, the underlying mechanism is unclear and the aligned fibers alone are not capable enough to commit teno-differentiation of stem cells. The uniqueness of our studies are as follows, based on our observation of reduced expression of histone deacetylases (HDACs) in tendon stem/progenitor cells (TSPCs) cultured on aligned fibers, we proposed a strategy to enhance the tenogenesis effect of aligned fibers by using a small molecule Trichostatin A (TSA), a HDAC inhibitor. Such a TSA-laden poly (l-lactic acid) (PLLA) aligned fiber (A-TSA) scaffold was successfully fabricated by a stable jet electrospinning method, and demonstrated its sustained capability in releasing TSA. The incorporation and subsequent release of bioactive small molecule TSA into electrospun aligned fibers allows a controllable manner for both biochemical and physical regulation of tenogenesis of stem cells both in vitro and in vivo. Collectively, the present study provides a model of "translating the biological knowledge learned from cell-material interaction into optimizing biomaterials (from Biomat-to-Biomat)".
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Affiliation(s)
- Can Zhang
- Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cell and Tissue Engineering, School of Medicine, Zhejiang University, Hangzhou 310058, China; Zhejiang Provincial Key Laboratory of Tissue Engineering and Regenerative Medicine, Hangzhou 310058, China; Institute of Bionanotechnology and Tissue Engineering, College of Biology, Hunan University, Changsha 410082, China
| | - Xianliu Wang
- College of Chemistry, Chemical Engineering and Biotechnology, Donghua University, Shanghai 201620, China
| | - Erchen Zhang
- Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cell and Tissue Engineering, School of Medicine, Zhejiang University, Hangzhou 310058, China; Zhejiang Provincial Key Laboratory of Tissue Engineering and Regenerative Medicine, Hangzhou 310058, China
| | - Long Yang
- Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cell and Tissue Engineering, School of Medicine, Zhejiang University, Hangzhou 310058, China; Zhejiang Provincial Key Laboratory of Tissue Engineering and Regenerative Medicine, Hangzhou 310058, China
| | - Huihua Yuan
- College of Chemistry, Chemical Engineering and Biotechnology, Donghua University, Shanghai 201620, China
| | - Wenjing Tu
- Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cell and Tissue Engineering, School of Medicine, Zhejiang University, Hangzhou 310058, China; Zhejiang Provincial Key Laboratory of Tissue Engineering and Regenerative Medicine, Hangzhou 310058, China
| | - Huilan Zhang
- College of Chemistry, Chemical Engineering and Biotechnology, Donghua University, Shanghai 201620, China
| | - Zi Yin
- Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cell and Tissue Engineering, School of Medicine, Zhejiang University, Hangzhou 310058, China; Zhejiang Provincial Key Laboratory of Tissue Engineering and Regenerative Medicine, Hangzhou 310058, China
| | - Weiliang Shen
- Department of Orthopedic Surgery, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, China
| | - Xiao Chen
- Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cell and Tissue Engineering, School of Medicine, Zhejiang University, Hangzhou 310058, China; Zhejiang Provincial Key Laboratory of Tissue Engineering and Regenerative Medicine, Hangzhou 310058, China.
| | - Yanzhong Zhang
- China Orthopedic Regenerative Medicine Group (CORMed), Hangzhou 310058, China; College of Chemistry, Chemical Engineering and Biotechnology, Donghua University, Shanghai 201620, China.
| | - Hongwei Ouyang
- Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cell and Tissue Engineering, School of Medicine, Zhejiang University, Hangzhou 310058, China; Zhejiang Provincial Key Laboratory of Tissue Engineering and Regenerative Medicine, Hangzhou 310058, China; Department of Sports Medicine, School of Medicine, Zhejiang University, Hangzhou 310058, China; State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310058, China.
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17
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Alušík Š, Paluch Z. [Drug induced tendon injury]. Vnitr Lek 2018; 63:967-971. [PMID: 29334747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Tendon injury belongs to the less known side effects of some drugs, reported until recently only for glucocorticoids and fluoroquinolones. To date, some other classes of drugs such as statins, aromatase inhibitors, anabolic steroids, potentially causing tendon injury, have been added to the list. The authors discuss the most common clinical presentations, diagnosis, and management as well as latest experimental data regarding this issue. The most often, the Achilles tendon is affected, however, nearly every tendon of the entire body may be affected. Tendon rupture or drug induced tendinopathy should be strongly considered in those who have a tendon injury and have recently taken these drugs.Key words: anabolic steroids - aromatase inhibitors - fluoroquinolones - glucocorticoids - statins - tendon injury.
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18
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Gabler C, Gierschner S, Tischer T, Bader R. Comparison of different suture techniques for Achilles tendon repair in rat model using collagen scaffolds. Acta Bioeng Biomech 2018; 20:73-77. [PMID: 30220720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE Tendon injury is an increasing problem in orthopedic and trauma surgery due to aging of the population and increased activity demands. Many rodent animal models are used in order to evaluate tendon reconstruction. Although tendon reruptures are a well- -known clinical problem, the outcomes of tendon repair in animal models are rarely discussed in the literature. The goal of the present experimental study was to compare the primary fixation stability of three suture techniques for repair of Achilles tendon defects in a rat model using a collagen scaffold. METHODS Cadaveric left hind limbs of Sprague-Dawley rats were prepared with an Achilles tendon defect of 3 mm and rejoined using a collagen scaffold. Three suture configurations (simple, simple stitch with additional framing suture, and modified Mason-Allen stitch; n = 5 each) underwent tensile testing until complete failure was observed. RESULTS Under a load of a mean value of 6.6 N, the failure load of simple stitches was the significantly lowest ( p < 0.01). Both, modified Mason-Allen stitches and simple stitches with additional framing suture showed a mean failure load of more than 14 N. Regardless of the suture technique, most of the samples showed failure of tendon due to suture tear-out. The suture material as well as the scaffold remained mostly intact. CONCLUSIONS Although simple end-to-end suture techniques are common in the literature, stitches with more suture strands should be preferred. Using techniques like an additional framing suture or modified Mason-Allen stitch, maximum failure load can be doubled and the risk of tendon rerupture may be decreased within in vivo testing.
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Affiliation(s)
- Carolin Gabler
- University Medicine Rostock, Department of Orthopedics, Biomechanics and Implant Technology Laboratory, Rostock, Germany
| | - Susann Gierschner
- University Medicine Rostock, Department of Orthopedics, Biomechanics and Implant Technology Laboratory, Rostock, Germany
| | - Thomas Tischer
- University Medicine Rostock, Department of Orthopedics, Biomechanics and Implant Technology Laboratory, Rostock, Germany
| | - Rainer Bader
- University Medicine Rostock, Department of Orthopedics, Biomechanics and Implant Technology Laboratory, Rostock, Germany
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Tang L, Yang Y, Li Y, Yang G, Luo T, Xu Y, Zhang W. Knitted silk mesh-like scaffold incorporated with sponge-like regenerated silk fibroin/collagen I and seeded with mesenchymal stem cells for repairing Achilles tendon in rabbits. Acta Bioeng Biomech 2018; 20:77-87. [PMID: 30520436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
A scaffold knit with natural sericin-free silk fibroin fiber possesses desirable mechanical properties, biocompatibility, ease of fabrication, and slow degradability. However, regenerated silk fibroin degrades faster than natural silk. In this study, natural silk fibroin fiber mesh-like scaffolds were prepared by a weft-knitting method and the pores were filled with sponge-like regenerated silk fibroin-collagen I. The microporous sponge and mesh-like scaffolds were fused to achieve gradient degradation of the scaffolds, and rabbit bone marrow mesenchymal stem cells (BMSCs) were seeded onto the scaffolds to form scaffold-BMSCs composites. The composites were implanted into gap defects made in the rabbit Achilles tendon. Twenty weeks after implantation, histological observation showed that tendon-like tissue had formed, collagen I mRNA was expressed, abundant collagen was generated, and that there was no obvious degradation of silk. The maximum load of the neo-Achilles tendon was 62.14% that of the natural Achilles tendon. These outcomes were superior to those obtained in the group implanted with a scaffold without BMSCs. These findings suggest the feasibility of constructing tissue-engineered tendons using weft-knitted silk scaffolds incorporated with sponge-like regenerated silk fibroin/collagen I and seeded with BMSCs, and show potential of the scaffold-BMSCs composites to repair Achilles tendon defects.
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Affiliation(s)
- Liang Tang
- Institute of Health Food, Zhejiang Academy of Medical Sciences, Hangzhou, Zhejiang Province, China
| | - Yadong Yang
- Institute of Bioengineering, Zhejiang Academy of Medical Sciences, Hangzhou, Zhejiang Province, China
| | - Yuezhong Li
- Institute of Health Food, Zhejiang Academy of Medical Sciences, Hangzhou, Zhejiang Province, China
| | - Geng Yang
- Institute of Bioengineering, Zhejiang Academy of Medical Sciences, Hangzhou, Zhejiang Province, China
| | - Tao Luo
- Institute of Bioengineering, Zhejiang Academy of Medical Sciences, Hangzhou, Zhejiang Province, China
| | - Yimeng Xu
- Institute of Bioengineering, Zhejiang Academy of Medical Sciences, Hangzhou, Zhejiang Province, China
| | - Wenyuan Zhang
- Institute of Bioengineering, Zhejiang Academy of Medical Sciences, Hangzhou, Zhejiang Province, China
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20
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Unlu MC, Kivrak A, Kayaalp ME, Birsel O, Akgun I. Peritendinous injection of platelet-rich plasma to treat tendinopathy: A retrospective review. Acta Orthop Traumatol Turc 2017; 51:482-487. [PMID: 29108884 PMCID: PMC6197157 DOI: 10.1016/j.aott.2017.10.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 09/18/2017] [Accepted: 10/12/2017] [Indexed: 12/29/2022]
Abstract
Objective The aim of this study was to determine factors associated with the likelihood of a better clinical outcome after the peritendinous injection of PRP for the treatment of chronic tendinopathy and identify whether PRP represents an effective treatment option for chronic tendinopathies. Methods The study included 214 patients (86 males and 128 females; mean age: 39.3 (18–75) years) who received PRP injections for tendinopathy refractory to conventional treatments. The mean duration of symptoms at the moment of the PRP treatment was 8.3 months. Primary outcome measurement was perceived improvement in symptoms for each anatomic compartment for upper and lower limbs at 6 months after treatment. Also, a visual analog scale (VAS) score (pain intensity on a 0–10 scale) was used for pain scoring questionnaire before treatment, 6 weeks and 6 months following the PRP injection(s). To identify factors associated with the likelihood of a better clinical outcome, patients were categorized on the basis of their perceived improvement in symptoms 6 months after the PRP injection(s)—that is, as lower (less than 50% global improvement) or higher (more than 50% global improvement). Results A visual analogue scale score and perceived improvement in symptoms were significantly lower after peritendinous injection in 6-week and 6-month follow-ups compared with the baseline (P < 0.001) except for peroneal and Achilles tendons. Overall, 83% of patients indicated moderate to complete improvement in symptoms. The most common injection sites were the lateral epicondyle, Achilles, and patellar tendons. Furthermore, 30% of patients received only 1 injection, 30% received 2 injections, and 40% received 3 or more injections. A total of 85% of patients were satisfied (more than 50% global improvement) with the procedure. In addition, upper limb tendons, increase in the age, and female gender were associated with a higher likelihood of perceived improvement in symptoms. Conclusions In the present retrospective study assessing PRP injections in the treatment of chronic tendinopathy, a moderate improvement (>50%) in pain symptoms was observed in most of the patients. Our research found that results were most promising with patellar and lateral epicondylar tendinopathy in the short to medium term. Female patients, patients with upper extremity tendinopathy and older patients appeared to benefit more from PRP injection. Level of evidence Level IV, Therapeutic study.
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Affiliation(s)
- Mehmet Can Unlu
- Istanbul University, Cerrahpasa Medical Faculty, Department of Orthopedics and Traumatology, Istanbul, Turkey.
| | - Aybars Kivrak
- Istanbul University, Cerrahpasa Medical Faculty, Department of Orthopedics and Traumatology, Istanbul, Turkey.
| | - Mahmut Enes Kayaalp
- Istanbul University, Cerrahpasa Medical Faculty, Department of Orthopedics and Traumatology, Istanbul, Turkey.
| | - Olgar Birsel
- Koc University Hospital, Department of Orthopedics and Traumatology, Istanbul, Turkey.
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21
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Abstract
Toxic tendinopathy is a rare but reproducible complication in humans, given agents of four drug classes: aromatase inhibitors, fluoroquinolone antibiotics, glucocorticoids (long-term regimens), and statins. Toxic tendinopathy in humans has been linked less consistently to treatment with anabolic steroids, antiretroviral agents (mainly protease inhibitors), metalloproteinase inhibitors (MMPI), and isotretinoin. Classic drug-induced tendinopathies appear as "tendinosis" (i.e., progressive tendon degeneration without inflammation), although cases associated with aromatase inhibitors exhibit mainly tenosynovitis. Any tendon may be affected, but fluoroquinolones, glucocorticoids, and statins most frequently affect large load-bearing tendons in the lower limb, especially the calcaneal ("Achilles") tendon-which ruptures in approximately 30 to 40% of cases. The time to symptom onset ranges from days (fluoroquinolones) to weeks, months, or even years. The pathogenesis is incompletely understood, but proposed mechanisms include apoptosis of tenoblasts and tenocytes, deficient tenocyte function (leading to abnormal extracellular matrix maintenance and repair as well as disrupted intercellular signaling), and structural disintegration (via a combination of increased expression of lytic enzymes, lessened cholesterol content in cell membranes, and neoangiogenesis within highly ordered tendon tissue). Nonclinical safety assessment of therapeutic candidates in these drug classes should incorporate tendon routinely as a protocol-specified tissue for pathology evaluation.
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Affiliation(s)
- Brad Bolon
- 1 GEMpath, Inc., Longmont, Colorado, USA
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22
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Fridén T, Movin T, Andrén-Sandberg Å. [Missed diagnosis of Achilles tendon ruptures most common in elderly patients]. Lakartidningen 2017; 114:EHTD. [PMID: 28535025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
We audited forty-six patients with a rupture of the Achilles tendon notified to the Swedish regulatory authority (the Health and Social Care Inspectorate) due to suspicion of malpractice. The patients' history and clinical presentation differed from those with a more classical acute rupture. The diagnostic errors were often found in patients older than 60 years, they were just as common in women as in men and the symptoms often had a subacute start. In most patients, the diagnostic errors were due to an incomplete clinical examination. More than one fourth of the patients were on medication with statins or quinolones.
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Affiliation(s)
- Thomas Fridén
- Inspektionen för vård och omsorg - Stockholm, Sweden Inspektionen för vård och omsorg - Stockholm, Sweden
| | - Tomas Movin
- Karolinska Institutet Department of Clinical Science and Education Sodersjukhuset - Stockholm, Sweden - Stockholm, Sweden
| | - Åke Andrén-Sandberg
- Karolinska Universitetssjukhuset - Gastrocentrum kirurgi Stockholm, Sweden Karolinska Universitetssjukhuset - Gastrocentrum Stockholm, Sweden
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Abstract
OBJECTIVES To determine if a topically applied non-steroidal anti-inflammatory drug (diclofenac) can provide short-term pain relief for chronic Achilles tendinopathy (CAT), in order to inform the development of a new rehabilitation protocol. DESIGN AND SETTING Pilot double-blind, cross-over randomised controlled trial providing participants with tertiary care. The study was conducted at a single research centre in Vancouver, BC. PARTICIPANTS Sixteen adults with unilateral CAT and three adults with bilateral CAT participated. INTERVENTIONS Participants received two successive treatments (10% diclofenac gel or placebo gel) in random order over a 3-day period. There was a 1-week washout period between the treatments. Allocation was by simple randomisation, and the participants as well as the assessing/treating researcher were blinded to treatment allocation. OUTCOME MEASURES The primary outcome measure was pain level (0-10) during tendon loading (hopping). Secondary outcome measures included pain at rest, pressure pain threshold of the Achilles tendon and symptom improvement. RESULTS Nineteen adults participated in the study, and all were included in the analysis. Diclofenac gel significantly reduced the average pain during tendon loading (p<0.001) and at rest (p=0.031). The average baseline hopping pain was 4.8/10 (95% CI 3.92 to 5.68) and was reduced to 3.1/10 (2.35-3.85) by diclofenac. Pain at rest was decreased and pressure pain threshold increased with diclofenac treatment, but not with placebo gel. There were no observed or reported side effects of either treatment. CONCLUSIONS In this small, short-term study, diclofenac was able to improve symptoms and reduce pain during tendon loading in participants with CAT, whereas placebo gel was not. A future study of diclofenac as a supplement to rehabilitation, with longer follow-up and powered to detect a difference between diclofenac and placebo, is indicated. TRIAL REGISTRATION ISRCTN60151284, http://www.isrctn.com/ISRCTN60151284 ETHICS: UBC Clinical Research Ethics Board approval was obtained for this research. The certificate number of the ethics certificate of approval to conduct research is H15-00999.
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Affiliation(s)
| | - Brian Cairns
- Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
- Health Science and Technology, Aalborg Universitet, Aalborg, Denmark
| | - Jim Bovard
- Family Practice, University of British Columbia, Vancouver, Canada
| | - Alexander Scott
- Physical Therapy, University of British Columbia, Vancouver, Canada
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Abstract
Mechanical stress plays an important role in preserving the integrity of bone and ligament. Stress shielding reduces mechanical load on bone or tendons, resulting in tissue degradation. Previous studies showed that deterioration of the tendon structure during stress shielding is associated with elevated expression of tumor necrosis factor (TNF)-α. This study examined the therapeutic potential of the TNF inhibitor etanercept in preventing morphologic deterioration of the Achilles tendon after stress shielding. Rats (N=48) were exposed to stress shielding of the left Achilles tendon and treated with etanercept or phosphate-buffered saline for 2 or 4 weeks. The right Achilles tendons were used as controls. After 2 or 4 weeks, stress-shielded tendons appeared less smooth than control tendons, and the stress-shielded tendons formed adhesions with surrounding tissues. Transmission electron microscopy also showed disarray of the collagen fibrils and a significant increase in the number of small-diameter collagen fibrils. These changes were associated with increased expression of TNF-α, matrix metalloproteinase (MMP)-13, MMP-3, collagen I, and collagen III. Treatment with 2 weeks of etanercept injection reduced morphologic changes in collagen organization and structure induced by stress shielding. Etanercept treatment also attenuated upregulation of MMP-13, MMP-3, and collagen III levels. However, no significant difference was observed between the etanercept group and the phosphate-buffered saline group after 4 weeks of treatment. The current findings show that TNF-α inhibition can protect against the early stages of tendon tissue remodeling induced by stress shielding, but additional interventions may be necessary to prevent tendon degeneration with long-term stress shielding. [Orthopedics. 2017; 40(1):49-55.].
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25
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Perucca Orfei C, Lovati AB, Viganò M, Stanco D, Bottagisio M, Di Giancamillo A, Setti S, de Girolamo L. Dose-Related and Time-Dependent Development of Collagenase-Induced Tendinopathy in Rats. PLoS One 2016; 11:e0161590. [PMID: 27548063 PMCID: PMC4993508 DOI: 10.1371/journal.pone.0161590] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 08/08/2016] [Indexed: 12/20/2022] Open
Abstract
Tendinopathy is a big burden in clinics and it represents 45% of musculoskeletal lesions. Despite the relevant social impact, both pathogenesis and development of the tendinopathy are still under-investigated, thus limiting the therapeutic advancement in this field. The purpose of this study was to evaluate the dose-dependent and time-related tissue-level changes occurring in a collagenase-induced tendinopathy in rat Achilles tendons, in order to establish a standardized model for future pre-clinical studies. With this purpose, 40 Sprague Dawley rats were randomly divided into two groups, treated by injecting collagenase type I within the Achilles tendon at 1 mg/mL (low dose) or 3 mg/mL (high dose). Tendon explants were histologically evaluated at 3, 7, 15, 30 and 45 days. Our results revealed that both the collagenase doses induced a disorganization of collagen fibers and increased the number of rounded resident cells. In particular, the high dose treatment determined a greater neovascularization and fatty degeneration with respect to the lower dose. These changes were found to be time-dependent and to resemble the features of human tendinopathy. Indeed, in our series, the acute phase occurred from day 3 to day 15, and then progressed towards the proliferative phase from day 30 to day 45 displaying a degenerative appearance associated with a very precocious and mild remodeling process. The model represents a good balance between similarity with histological features of human tendinopathy and feasibility, in terms of tendon size to create lesions and costs when compared to other animal models. Moreover, this model could contribute to improve the knowledge in this field, and it could be useful to properly design further pre-clinical studies to test innovative treatments for tendinopathy.
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Affiliation(s)
- Carlotta Perucca Orfei
- Orthopaedic Biotechnology Laboratory, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
- Department of Drug Sciences, University of Pavia, Pavia, Italy
| | - Arianna B. Lovati
- Cell and Tissue Engineering Laboratory, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
| | - Marco Viganò
- Orthopaedic Biotechnology Laboratory, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
- Department of Biotechnology and Biosciences, University of Milano-Bicocca, Milan, Italy
| | - Deborah Stanco
- Orthopaedic Biotechnology Laboratory, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
| | - Marta Bottagisio
- Cell and Tissue Engineering Laboratory, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
- Department of Veterinary Medicine (DiMeVet), University of Milan, Milan, Italy
| | | | | | - Laura de Girolamo
- Orthopaedic Biotechnology Laboratory, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
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26
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Tendon disorders with ofloxacin ear drops. Prescrire Int 2016; 25:72. [PMID: 27213194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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27
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Yuan T, Zhang J, Zhao G, Zhou Y, Zhang CQ, Wang JHC. Creating an Animal Model of Tendinopathy by Inducing Chondrogenic Differentiation with Kartogenin. PLoS One 2016; 11:e0148557. [PMID: 26848746 PMCID: PMC4744046 DOI: 10.1371/journal.pone.0148557] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Accepted: 01/20/2016] [Indexed: 11/18/2022] Open
Abstract
Previous animal studies have shown that long term rat treadmill running induces over-use tendinopathy, which manifests as proteoglycan accumulation and chondrocytes-like cells within the affected tendons. Creating this animal model of tendinopathy by long term treadmill running is however time-consuming, costly and may vary among animals. In this study, we used a new approach to develop an animal model of tendinopathy using kartogenin (KGN), a bio-compound that can stimulate endogenous stem/progenitor cells to differentiate into chondrocytes. KGN-beads were fabricated and implanted into rat Achilles tendons. Five weeks after implantation, chondrocytes and proteoglycan accumulation were found at the KGN implanted site. Vascularity as well as disorganization in collagen fibers were also present in the same site along with increased expression of the chondrocyte specific marker, collagen type II (Col. II). In vitro studies confirmed that KGN was released continuously from KGN-alginate in vivo beads and induced chondrogenic differentiation of tendon stem/progenitor cells (TSCs) suggesting that chondrogenesis after KGN-bead implantation into the rat tendons is likely due to the aberrant differentiation of TSCs into chondrocytes. Taken together, our results showed that KGN-alginate beads can be used to create a rat model of tendinopathy, which, at least in part, reproduces the features of over-use tendinopathy model created by long term treadmill running. This model is mechanistic (stem cell differentiation), highly reproducible and precise in creating localized tendinopathic lesions. It is expected that this model will be useful to evaluate the effects of various topical treatments such as NSAIDs and platelet-rich plasma (PRP) for the treatment of tendinopathy.
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Affiliation(s)
- Ting Yuan
- MechanoBiology Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiaotong University, Shanghai, China
| | - Jianying Zhang
- MechanoBiology Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | - Guangyi Zhao
- MechanoBiology Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | - Yiqin Zhou
- MechanoBiology Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | - Chang-Qing Zhang
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiaotong University, Shanghai, China
| | - James H-C. Wang
- MechanoBiology Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
- * E-mail:
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28
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Abstract
Exploration into the molecular aspects of the healing process has led to the development of autologous and recombinant biologic agents. These products, collectively known as orthobiologics, have the potential to optimize favorable outcomes with respect to bone and soft-tissue restoration and to maximize the natural healing response. These orthobiologics include platelet-derived growth factor, bone morphogenetic proteins, and platelet-rich plasma. Although the usefulness of these growth factors is well described in various fields of surgery, few data exist to support or oppose the specific application of growth factors in foot and ankle surgery.
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Affiliation(s)
- Sheldon S Lin
- From Rutgers New Jersey Medical School, Department of Orthopedics, Newark, NJ
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Saute JA, Giugliani R, Merkens LS, Chiang JPW, DeBarber AE, de Souza CFM. Look carefully to the heels! A potentially treatable cause of spastic paraplegia. J Inherit Metab Dis 2015; 38:363-4. [PMID: 25112387 DOI: 10.1007/s10545-014-9745-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 07/02/2014] [Accepted: 07/07/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Jonas Alex Saute
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre (HCPA), Rua Ramiro Barcelos 2350, Zip Code 90.035-903, Porto Alegre, RS, Brazil,
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30
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Chen Q, Lu H, Yang H. Chitosan inhibits fibroblasts growth in Achilles tendon via TGF-β1/Smad3 pathway by miR-29b. Int J Clin Exp Pathol 2014; 7:8462-8470. [PMID: 25674210 PMCID: PMC4313955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 12/01/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND AND AIM Chitosan, is a natural polymer, plays an important role in prevention of tendon adhesion in tendon healing process. However, the molecular mechanisms underlying the prevention effect is unclear. Here we investigated the effects of chitosan on Achilles tendon injury rats and fibroblasts. METHODS Eight weeks after surgery, gliding excursion and the content of collagen fibers in Achilles tendon injury rats were determined to evaluate the chitosan effect on tendon healing. Fibroblasts isolated from scar tissue of repaired tendon were treated with different concentration of chitosan, and then cell inhibition, apoptosis and cell cycle were measured using MTT and Flow Cytometry respectively. The expression of microRNAs (miRNAs) was quantified by real-time PCR and protein expression of TGF-β1, Smad3 and P21 were quantified by western blotting. MiR-29b inhibitor was transfected in cells to evaluate the mechanism underlying the effects of chitosan on tendon fibroblasts. RESULTS The gliding excursion of repaired tendon was increased and the content of collagen fibers was decreased by chitosan in rats. Chitosan inhibited the fibroblasts growth and arrested cells in G1 phase. Chitosan also elevated the expression of miR-29b and P21 while reduced the levels of TGFβ1 and Smad3 in both repaired tendon and fibroblasts. In addition, miR-29b inhibitor revered the effects of chitosan on fibroblasts. CONCLUSIONS The current study demonstrated that chitosan improving the condition of tendon healing after surgery, which is reduced by the high expression of miR-29b and its down-regulation of TGF-β1/Smad3 level and inhibition of fibroblasts growth.
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Affiliation(s)
- Qiang Chen
- Department of Hand Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University China
| | - Hui Lu
- Department of Hand Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University China
| | - Hu Yang
- Department of Hand Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University China
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Chang CH, Tsai WC, Hsu YH, Pang JHS. Pentadecapeptide BPC 157 enhances the growth hormone receptor expression in tendon fibroblasts. Molecules 2014; 19:19066-77. [PMID: 25415472 PMCID: PMC6271067 DOI: 10.3390/molecules191119066] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 11/12/2014] [Accepted: 11/13/2014] [Indexed: 12/11/2022] Open
Abstract
BPC 157, a pentadecapeptide derived from human gastric juice, has been demonstrated to promote the healing of different tissues, including skin, muscle, bone, ligament and tendon in many animal studies. However, the underlying mechanism has not been fully clarified. The present study aimed to explore the effect of BPC 157 on tendon fibroblasts isolated from Achilles tendon of male Sprague-Dawley rat. From the result of cDNA microarray analysis, growth hormone receptor was revealed as one of the most abundantly up-regulated genes in tendon fibroblasts by BPC 157. BPC 157 dose- and time-dependently increased the expression of growth hormone receptor in tendon fibroblasts at both the mRNA and protein levels as measured by RT/real-time PCR and Western blot, respectively. The addition of growth hormone to BPC 157-treated tendon fibroblasts dose- and time-dependently increased the cell proliferation as determined by MTT assay and PCNA expression by RT/real-time PCR. Janus kinase 2, the downstream signal pathway of growth hormone receptor, was activated time-dependently by stimulating the BPC 157-treated tendon fibroblasts with growth hormone. In conclusion, the BPC 157-induced increase of growth hormone receptor in tendon fibroblasts may potentiate the proliferation-promoting effect of growth hormone and contribute to the healing of tendon.
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Affiliation(s)
- Chung-Hsun Chang
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, 259 Wen-Hwa 1st Road, Kwei-Shan, Tao-Yuan 333, Taiwan.
| | - Wen-Chung Tsai
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kwei-Shan, Tao-Yuan 333, Taiwan.
| | - Ya-Hui Hsu
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, 259 Wen-Hwa 1st Road, Kwei-Shan, Tao-Yuan 333, Taiwan.
| | - Jong-Hwei Su Pang
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, 259 Wen-Hwa 1st Road, Kwei-Shan, Tao-Yuan 333, Taiwan.
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32
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Maquirriain J, Kokalj A. Acute Achilles tendinopathy: effect of pain control on leg stiffness. J Musculoskelet Neuronal Interact 2014; 14:131-136. [PMID: 24583548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Tendinopathies are a major cause of disability in the athletic population; the main purpose of the treatment of these injuries is to reduce pain and improve function. The aim of this study was to evaluate the effect of NSAIDs on leg stiffness of patients suffering acute unilateral Achilles tendinopathy. Twenty-eight eligible male athletes (aged 39.1 ± 10.3 y) suffering acute Achilles tendinopathy were treated with etoricoxib (120 mg oral once daily) during 7 days. Pain (100-mm visual analogue scale-VAS), analgesic effect (percentage of 100-mm VAS reduction), and leg stiffness were evaluated pre- and post- anti-inflammatory treatment. Results of this study showed that over the 7-day treatment period, etoricoxib provided significant relief of Achilles tendon pain (VAS) compared to that experienced at baseline: 54.5 ± 21.6 and 24.5 ± 24.8, respectively (p<0.001). Leg stiffness showed a significant improvement after one-week NSAID therapy: LSR 0.89 ± 0.1 vs. 0.97 ± 0.1; (p=0.02). In conclusion, findings of this study demonstrated that patients suffering acute unilateral Achilles tendinopathy increased their leg stiffness of the affected side after oral anti-inflammatory therapy. Effective control of tendon pain in the acute phase of such sports-related injuries may contribute to improve capabilities associated with high performance like leg stiffness.
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Affiliation(s)
- J Maquirriain
- High Performance National Sports Center (CeNARD) and CONICET, Buenos Aires, Argentina
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33
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Solchaga LA, Bendele A, Shah V, Snel LB, Kestler HK, Dines JS, Hee CK. Comparison of the effect of intra-tendon applications of recombinant human platelet-derived growth factor-BB, platelet-rich plasma, steroids in a rat achilles tendon collagenase model. J Orthop Res 2014; 32:145-50. [PMID: 24018586 DOI: 10.1002/jor.22483] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 08/14/2013] [Indexed: 02/04/2023]
Abstract
This study compared the effect of intra-tendon (IT) delivery of recombinant human platelet-derived growth factor-BB (rhPDGF-BB), platelet-rich plasma (PRP) and corticosteroids in a rat tendinopathy model. Seven days after collagenase induction of tendinopathy, a 30-µl IT injection was administered. Treatments included: saline; 3 µg rhPDGF-BB; 10 µg rhPDGF-BB; PRP; and 300 µg triamcinolone acetonide (TCA). Outcomes were assessed 7 and 21 days after treatment. All groups exhibited good to excellent repair. Relative to saline, cell proliferation increased 65% in the 10 µg rhPDGF-BB group and decreased 74% in the TCA group; inflammation decreased 65% in the TCA group. At 7 days, maximum load-to-failure was increased in the 3 µg rhPDGF-BB group relative to saline, PRP, and TCA (p < 0.025). On day 21, maximum load-to-rupture was increased in the 10 µg rhPDGF-BB group relative to saline, PRP, and TCA (p < 0.035) and in the 3 µg rhPDGF-BB group compared to saline and TCA (p < 0.027). Stiffness in the 10 µg rhPDGF-BB group was increased compared to saline, PRP, and TCA (p < 0.038). Histology demonstrated similar repair in all groups. PRP and TCA did not improve mechanical properties compared to saline. Injections of rhPDGF-BB increased maximum load-to-failure (3 and 10 µg) and stiffness (10 µg) relative to controls and commonly used treatments. © 2013 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 32:145-150, 2014.
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Affiliation(s)
- Luis A Solchaga
- Research and Development, BioMimetic Therapeutics, LLC, Franklin, Tennessee
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Lee GJ, Choi S, Chon J, Yoo SD, Kim HS, Park HK, Chung JH. Nanostructural and nanomechanical responses of collagen fibrils in the collagenase-induced Achilles tendinitis rat model. J Nanosci Nanotechnol 2013; 13:7279-7286. [PMID: 24245243 DOI: 10.1166/jnn.2013.8092] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Achilles tendons are vulnerable to acute or chronic injuries that lead to inflammation. We investigated nanostructural and nanomechanical changes in collagen fibrils from rat Achilles tendons over a period of 9 weeks after injury using atomic force microscopy (AFM). To evaluate the nanostructural changes in Achilles tendons, we measured the diameter and D-banding of collagen fibrils by AFM. And the adhesion forces, which were related to cross-linking of collagen, were calculated from the retraction process of a force-distance curve. We successfully observed the time course of changes in collagen fibrils during healing using AFM. The diameters and D-banding in healed tendons were similar to those of uninjured tendons at 9 weeks after injury, but the adhesion forces remained different from those of uninjured tendons. Our AFM results depicted the minute changes in Achilles tendon surface by natural healing quite well, even drawbacks to naturally healed tendon. Understanding changes in collagen cross-linking and structure while healing will lead to better understanding of healing mechanisms and subsequent improvements in treatment. And AFM can be applied as powerful tool to evaluate structural and property changes in collagen fibrils before and after injury and/or treatment in Achilles tendon.
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Affiliation(s)
- Gi-Ja Lee
- Department of Biomedical Engineering and Healthcare Industry Research Institute, College of Medicine, Kyung Hee University, Seoul 130-701, Korea
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Abstract
We report the case of a 73 year old patient with a COPD. A severe exazerbation was treated with glucocorticoids and Quinolones. A few days later both ankles were tender and painful. Ultrasound examination showed bilateral Achilles tendon ruptures. Diagnostics, etiology and therapeutic options are discussed.
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Affiliation(s)
- Stefanie Schuster
- Fachbereich Allgemeine Innere Medizin, Kantonsspital St. Gallen, St. Gallen, Switzerland
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Fluoroquinolones and tendon disorders: even after single-dose therapy. Prescrire Int 2012; 21:185. [PMID: 22852292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Zhang K, Wang L, Zhang S, Yu B, Liu F, Cui Z, Jin D, Bai X. Celecoxib inhibits the heterotopic ossification in the rat model with Achilles tenotomy. Eur J Orthop Surg Traumatol 2012; 23:145-8. [PMID: 23412444 DOI: 10.1007/s00590-012-0944-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2011] [Accepted: 01/20/2012] [Indexed: 11/30/2022]
Abstract
Celecoxib, a selective cox-2 inhibitor, has been shown to prevent the heterotopic ossification following total hip arthroplasty. However, the effects of celecoxib on heterotopic ossification at other locations remain unclear. This study aimed to investigate the effect of celecoxib on heterotopic ossification in the rat model with Achilles tenotomy. Forty male Sprague-Dawley rats, which were randomly divided into 2 groups (n = 20), underwent midpoint Achilles tenotomy on left legs through a posterior approach under aseptic condition. Experimental group was treated with the saline solution of celecoxib (10 mg/kg) per day, while control group was treated by normal saline (0.9%). At 3, 5 and 10 postoperative weeks, all animals were examined by X-ray to assess new bone formation in the Achilles tendon. At 10 weeks after surgery, all animals were killed and Achilles tendons were taken for hematoxylin-eosin (HE) and immunohistochemical staining. Heterotopic ossification developed in 3 rats (15%) in experimental group and 20 rats (100%) in control group by postoperative 10 weeks. The incidence of heterotopic ossification was significantly lower in experimental group than in control group (P < 0.05). Our findings suggest that celecoxib inhibits HO development in rat model with Achilles tenotomy.
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Affiliation(s)
- Kairui Zhang
- Department of Orthopedics and Traumatology, Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou avenue north, Guangzhou, 510515, China
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Pantalone A, Abate M, D'Ovidio C, Carnevale A, Salini V. Diagnostic failure of ciprofloxacin-induced spontaneous bilateral Achilles tendon rupture: case-report and medical-legal considerations. Int J Immunopathol Pharmacol 2011; 24:519-22. [PMID: 21658328 DOI: 10.1177/039463201102400227] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Rare side-effects of fluoroquinolone therapy are tendinitis and tendon rupture. Many reports have demonstrated that the concomitant use of corticosteroids, in patients aged 60 years or older, increase the risk substantially. We present a case of spontaneous bilateral Achilles tendon rupture induced by ciprofloxacin and methylprednisolone. A 61-year-old woman was diagnosed with Bronchiolitis Obliterans with Organizing Pneumonia (BOOP) and was started on oral ciprofloxacin 500 mg twice daily for 3 weeks and on oral methylprednisolone 16 mg twice daily for 2 weeks. The diagnosis was made after doctors, rather than stop drug therapy and advise complete rest, had mistakenly prescribed for the woman to undergo physiotherapy and local NSAIDs, thus favoring the onset of tendon ruptures and resulting in surgical and legal implications. Inspired by this case, we also submit a brief review on professional liability in Orthopaedics.
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Roy B, Nandi U, Das A, Pal TK. Acute and twenty-eight days repeated oral dose toxicity study of besifloxacin in Wistar albino rats. Environ Toxicol Pharmacol 2011; 32:82-101. [PMID: 21787734 DOI: 10.1016/j.etap.2011.03.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2010] [Revised: 03/27/2011] [Accepted: 03/28/2011] [Indexed: 05/31/2023]
Abstract
The purpose of this study was to investigate the potential acute and 28-day repeated oral toxicities of besifloxacin (BAF) in Wistar albino rats. In oral acute and repeated dose study, BAF was administered to both sex of rats, at dose levels of 0, 300, 600, 900 mg/kg/day and 0, 100, 200, 500 mg/kg/day, respectively. In the acute study, total white blood cell (WBC) (male, 43.74%; female, 42.60%) and total bilirubin (T-BIL) (male, 80%; female, 60%) were significantly increase, total protein (TP) (male, 23.24%; 27.80%) was significantly decreased, and significant incidence of pericholangitis (male, 83.33%; female, 75%) was shown in males and females of high-dose groups. In repeated oral dose toxicity study, similar type effects were also observed after serum hematological and serum biochemical analysis, whereas additionally sever hepatic injury and focal ulceration in gastric mucosa also observed in high dose groups of both sexes after histopathological analysis. However these toxic effects of besifloxacin were transient and reversible and no-observed adverse effect level (NOAEL) were 300 mg/kg/day for acute and 100 mg/kg/day for repeated dose toxicity study, respectively.
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Affiliation(s)
- Bikash Roy
- Bioequivalence Study Centre, Department of Pharmaceutical Technology, Jadavpur University, Kolkata 700032, India
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Tracy SC, Tasto JP, Oshima Y, Murata R, Garcia J, Amiel D. The effect of butyric acid on normal tendons: a potential stimulus for extracellular matrix expression. Am J Orthop (Belle Mead NJ) 2011; 40:142-147. [PMID: 21720603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We propose comparing angiogenic effects of butyric acid (BA)-impregnated suture vs control suture on an aged tendon model. Twenty-four 3-year-old rabbits underwent bilateral Achilles tendon exposure. BA-impregnated orthopedic suture was sutured into one side, and a control orthopedic suture into the contralateral side similarly. The rabbits were sacrificed at 7, 30, and 45 days and the tendons harvested for gross, histologic, and biochemical study. Histologically, there was increased vascularity/cell migration at all time points in the BA-treated tendons; proteoglycan expression (ie, safranin O staining) increased at 30 and 45 days. DNA concentration was significantly (P = .05) higher in the BA-treated tendon group relative to the control group at 7 days but was unchanged at 30 and 45 days. Similarly, messenger RNA (mRNA) expression of vascular endothelial growth factor (VEGF) was significantly (P = .05) higher in the BA-treated tendon at 7 days. A trend (P = .12) for higher expression in the BA group also was found at 30 days.
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Affiliation(s)
- Sean C Tracy
- San Diego Arthroscopy and Sports Medicine Center, San Diego, California, USA
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Aiyegbusi AI, Duru FIO, Awelimobor D, Noronha CC, Okanlawon AO. The role of aqueous extract of pineapple fruit parts on the healing of acute crush tendon injury. Nig Q J Hosp Med 2010; 20:223-227. [PMID: 21913532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND The Pineapple plant contains the enzyme bromelain which has been acclaimed to reduce pain and swellings following acute muscle injuries as well as carotenoids and polyphenols which are powerful antioxidants. It is yet to be determined if these constituents are distributed throughout the plant and what effect they have on the healing of acute tendon injuries. OBJECTIVE This study therefore investigated the effects of the aqueous extract of different parts of the pineapple plant on tenoblast proliferation and the tendon Malondialdehyde (MDA) level in the early stage of healing in a crush injury to the achilles tendon of Sprague-Dawley rats. METHODS Forty male rats were divided randomly into five groups; all had induced crush injury to the left Achilles tendon. Group 1; injury and nil treatment, Group 2; leaves extract, Group 3; fruit flesh extract, Group 4; bark extract, Group 5; core extract. The extract was given at a dosage of 30 mg/kg body weight daily over the first 14 days post-injury. On the 15th day post injury, the animals were sacrificed and the tendons excised and processed for histological study and MDA assay. RESULTS The flesh and bark extract induced a proliferation of tenoblasts which however was not significantly different from that of the untreated tendon while the leaves and core extracts reduced the population of the tenocytes. The flesh extract significantly (p < 0.05) reduced the MDA level while the leaves and core extract significantly (p < 0.001) increased it. The bark extract had no significant impact on the MDA level compared with the untreated tendon. CONCLUSION This study suggests that the anti-oxidant constituents of the pineapple plant are concentrated in the flesh while the bark and flesh extracts have the potential to promote healing by stimulating tenoblast proliferation.
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Affiliation(s)
- A I Aiyegbusi
- Department of Anatomy, College of Medicine, University of Lagos, Lagos.
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Abstract
Fluoroquinolones (FQs) represent a major class of antimicrobials that have a high potential as therapeutic agents. Although FQs are generally safe for the use as antimicrobials, they may induce tendinopathic complications such as tendinitis and tendon rupture. A number of factors have been suggested to further predispose a patient to such injuries. Hitherto, a few published cases on tendon disorders have implicated levofloxacin, a more recently introduced FQ. Here, we report a patient with levofloxacin-induced Achilles tendinitis, who exhibited no known predisposing factors. A 20-year-old man without any history of disease or medication presented with community-acquired pneumonia. Levofloxacin was administered and 3 days later, he complained of pain in the left Achilles tendon and revealed redness and swelling in the area. On suspecting Achilles tendinitis, levofloxacin treatment was discontinued, and the tendinitis subsequently improved. To our knowledge, this is the first case report on FQ-induced Achilles tendinitis in Korea.
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Affiliation(s)
- Areum Durey
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Yong Soo Baek
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Jin Seok Park
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Kwangsoo Lee
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Jeong-Seon Ryu
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Jin-Soo Lee
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Moon-Hyun Cheong
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
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Suwalski A, Dabboue H, Delalande A, Bensamoun SF, Canon F, Midoux P, Saillant G, Klatzmann D, Salvetat JP, Pichon C. Accelerated Achilles tendon healing by PDGF gene delivery with mesoporous silica nanoparticles. Biomaterials 2010; 31:5237-45. [PMID: 20334910 DOI: 10.1016/j.biomaterials.2010.02.077] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2010] [Accepted: 02/28/2010] [Indexed: 11/19/2022]
Abstract
We report the ability of amino- and carboxyl-modified MCM-41 mesoporous silica nanoparticles (MSN) to deliver gene in vivo in rat Achilles tendons, despite their inefficiency to transfect primary tenocytes in culture. We show that luciferase activity lasted for at least 2 weeks in tendons injected with these MSN and a plasmid DNA (pDNA) encoding the luciferase reporter gene. By contrast, in tendons injected with naked plasmid, the luciferase expression decreased as a function of time and became hardly detectable after 2 weeks. Interestingly, there were neither signs of inflammation nor necrosis in tendon, kidney, heart and liver of rat weekly injected with pDNA/MSN formulation during 1.5 months. Our main data concern the acceleration of Achilles tendons healing by PDGF-B gene transfer using MSN. Biomechanical properties and histological analyses clearly indicate that tendons treated with MSN and PDGF gene healed significantly faster than untreated tendons and those treated with pPDGF alone.
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Affiliation(s)
- Arnaud Suwalski
- Centre de Biophysique Moléculaire, CNRS UPR4301, Université d'Orléans and Inserm, rue Charles Sadron, 45071 Orléans Cedex 2, France
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Konerding MA, Arlt F, Wellmann A, Li V, Li W. Impact of combinatory growth factor application on rabbit Achilles tendon injury with operative versus conservative treatment: a pilot study. Int J Mol Med 2010; 25:217-224. [PMID: 20043130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
Acute Achilles tendon (AT) rupture is a common injury with a comparatively high complication rate. Presently, surgical treatments compete with nonoperative treatment modalities. The aim of this study was to elucidate the possible beneficial effects of short-term combinatory application of growth factors on tendon healing during operative or conservative treatment. In this controlled laboratory study, the left ATs of 40 adult New Zealand White rabbits were transected and either sutured or treated conservatively. Half of the animals from each treatment modality group repetitively received a mixture of VEGF165, bFGF, and rPDGF which was administered peritendineally. The left legs were immobilized with external fixateurs for 6 weeks. The ATs were harvested 3 months after intervention. Tensile strength tests revealed no significant differences between operative and conservative treatments. Compared to the normal right ATs, 60% of the average breaking strength was reached 3 months after surgery. Growth factor application did not result in significant improvements. Only a tendency towards higher blood vessel densities was noted in the groups treated with the factors. Collagen type I/III ratios also displayed no significant differences. This study indicates that there is no difference in the biomechanical outcome of conservative versus operative AT rupture treatment and only a marginal impact of short-term combinatory growth and angiogenesis factor application.
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Affiliation(s)
- Moritz A Konerding
- Institute of Anatomy and Cell Biology, University Medical Center of the Johannes Gutenberg University Mainz, D-55099 Mainz, Germany.
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Brcic L, Brcic I, Staresinic M, Novinscak T, Sikiric P, Seiwerth S. Modulatory effect of gastric pentadecapeptide BPC 157 on angiogenesis in muscle and tendon healing. J Physiol Pharmacol 2009; 60 Suppl 7:191-196. [PMID: 20388964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/15/2009] [Accepted: 12/11/2009] [Indexed: 05/29/2023]
Abstract
Angiogenesis is a natural and complex process controlled by angiogenic and angiostatic molecules, with a central role in healing process. One of the most important modulating factors in angiogenesis is the vascular endothelial growth factor (VEGF). Pentadecapeptide BPC 157 promotes healing demonstrating particular angiogenic/angiomodulatory potential. We correlated the angiogenic effect of BPC 157 with VEGF expression using in vitro (cell culture) and in vivo (crushed muscle and transected muscle and tendon) models. Results revealed that there is no direct angiogenic effect of BPC 157 on cell cultures. On the other hand, immunohistochemical analysis of muscle and tendon healing using VEGF, CD34 and FVIII antibodies showed adequately modulated angiogenesis in BPC 157 treated animals, resulting in a more adequate healing. Therefore the angiogenic potential of BPC 157 seems to be closely related to the healing process in vivo with BPC 157 stimulating angiogenesis by up-regulating VEGF expression.
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Affiliation(s)
- L Brcic
- Institute of Pathology, University of Zagreb Medical School, Zagreb, Croatia
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Fredberg U, Bolvig L, Pfeiffer-Jensen M, Clemmensen D, Jakobsen BW, Stengaard-Pedersen K. Ultrasonography as a tool for diagnosis, guidance of local steroid injection and, together with pressure algometry, monitoring of the treatment of athletes with chronic jumper's knee and Achilles tendinitis: a randomized, double‐blind, placebo‐controlled study. Scand J Rheumatol 2009; 33:94-101. [PMID: 15163110 DOI: 10.1080/03009740310004126] [Citation(s) in RCA: 114] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND The diagnosis of Achilles and patella tendinitis has until recently been based on clinical examination, and treatment with local steroid injection has been given blindly. This is the first randomized, double blind, placebo-controlled study of local steroid injection in athletes with chronic tendinitis, which used ultrasonography to increase diagnostic accuracy, to guide the correct placement of local steroid and, conjunctively with pressure algometry, to objectify and monitor the results of treatment. METHOD Forty-eight athletes each with severe symptomatic tendinitis of a patellar (24) or Achilles tendon (24) for more than 6 months, whose conditions were confirmed ultrasonographically, and who all failed conservative treatment (rehabilitation) were included in this double-blind, placebo-controlled study and treated with three ultrasonographically guided peritendinous injections of steroid or placebo. RESULTS The conditions of only one-third of the referred athletes with clinically suspected tendinitis were confirmed by ultrasonographic examination. The ultrasonographically guided peritendinous injection of steroid had a significant effect in reducing pain and thickening of tendons. CONCLUSION Ultrasonography should be used in the future to assure precise diagnosis and to guide the peritendinous injection of steroid in chronic Achilles and patella tendinitis. Ultrasonography and pressure algometry are recommended as objective methods for monitoring the effect of treatment. Ultrasonographically guided injection of long-acting steroid can normalize the ultrasonographic pathological lesions in the Achilles and patellar tendons, and has a dramatic clinical effect but when combined with aggressive rehabilitation with running after a few days, many will have relapse of symptoms within 6 months.
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Affiliation(s)
- U Fredberg
- Department of Internal Medicine, Silkeborg Central Hospital, Denmark.
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Petrou CG, Karachalios TS, Khaldi L, Karantanas AH, Lyritis GP. Calcitonin effect on Achilles tendon healing. An experimental study on rabbits. J Musculoskelet Neuronal Interact 2009; 9:147-154. [PMID: 19724149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE A positive potential effect of Calcitonin (CT) on Achilles tendon healing was investigated as well as the ability of MRI to follow the tendon healing process. MATERIALS AND METHODS A standardized tenotomy of the Achilles tendon was performed on forty-two rabbits. Twenty-one animals received daily 21 IU /kg Calcitonin intramuscularly (treatment group CT) during the experiment and the remaining received saline solution (control group P). Seven animals from each group were killed at one, two and three weeks postoperatively. All animals had serial MRI scans and tendon samples underwent biomechanical and histological testing. RESULTS For both groups, animals of the same subgroup showed statistically significant difference in signal intensity values of MRI between the 1st and 3rd week (p<0.001) and between the 2nd and 3rd week (p<0.001). Signal intensity values of MRI didn't show any differences between animals under treatment and controls measured at 1st (p=0.23), 2nd (p=0.23) and 3rd (p=0.53) postoperative week. Tendon samples from group CT showed statistically significant difference in ultimate tensile strength compared to controls at 2 (p<0,0005) and 3 (p<0,0005) weeks post-surgery. Histology showed a positive Calcitonin effect at all tendon healing stages. CONCLUSION It is suggested that Calcitonin enhances Achilles tendon healing process.
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Affiliation(s)
- C G Petrou
- Department of Orthopaedics, Hatzicostas General Hospital, Messolongi, Greece
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Aktaş RG, Aktaş S, Yazgan O, Altaner S. The effects of long-term low-dose cyclosporin A treatment on muscles and tendons: an experimental study. ULUS TRAVMA ACIL CER 2009; 15:317-323. [PMID: 19669958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND Limited studies report that patients receiving immunosuppressive therapy, including cyclosporin A (CsA), face muscle and/or tendon pathologies. The current study aimed (i) to investigate if CsA cause changes in the microscopic structure of striated muscle tissues and tendons after long-term low-dose therapy and (ii) to examine if the vehicle of CsA, Cremophor EL, or steroid administration might cause additional effects. METHODS Twenty-four adult female Sprague-Dawley rats weighing 230-300 g were divided at random into four groups. Group 1 served as the control. Groups 2-4 received CsA intraperitoneally for 2.5 months: Group 2 received the oral form of CsA, Group 3 received the intravenous form of CsA, which contains Cremophor EL, and Group 4 received the intravenous form of CsA and prednisolone. Samples from the Achilles tendons and triceps surae muscles were examined at light microscope level. RESULTS Focal necrotic areas, enlargement of connective tissue and increase in mononuclear cells were clear on muscles in the experimental groups. No morphologic effects were observed on tendons. CONCLUSION Long-term low-dose CsA therapy causes focal microscopic changes in muscles but not in tendons. No additional effects were demonstrated with Cremophor EL or steroids. It should be noted that muscle tissue damage after trauma or surgeries in patients receiving CsA might be more dramatic due to the pathologic changes already caused by CsA, as supported by several case reports.
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50
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Abstract
Derivatives of testosterone or of 19-nor-testosterone are used as anabolics for the purpose of improving performance although the effect of anabolics is known still to be under discussion. The use of anabolic steroids continues among competitive athletes despite increased controls and increasingly frequent dramatic incidents connected with them. Whereas metabolic dysfunction during anabolic use is well documented, ruptures of the large tendons are rarely reported. Within 18 months, a 29-year-old professional footballer needed surgery for rupture of the patellar tendon and of both Achilles tendons. Carefully directed questioning elicited confirmation that he had taken different anabolic steroids regularly for 3 years with the intention of improving his strength. After each operation anabolic steroids were taken again at a high dosage during early convalescence and training. Minimally invasive surgery and open suturing techniques led to complete union of the Achilles tendons in good time. Training and anabolic use (metenolon 300 mg per week) started early after suturing of the patellar tendon including bone tunnels culminated in histologically confirmed rerupture after 8 weeks. After a ligament reconstruction with a semitendinosus tendon graft with subsequent infection, the tendon and reserve traction apparatus were lost. Repeated warnings of impaired healing if anabolic use was continued had been given without success. In view of the high number of unrecorded cases in competitive and athletic sports, we can assume that the use of anabolic steroids is also of quantitative relevance in the operative treatment of tendon ruptures.
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Affiliation(s)
- J Isenberg
- Klinik und Poliklinik für Unfall-, Hand und Wiederherstellungschirurgie, Klinikum der Universität zu Köln, Joseph-Stelzmann-Strasse 9, 50924, Köln.
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